Although many nurses routinely disclose nursing errors to their patients, they're often not included when physicians tell patients about serious medical mistakes, according to a new study. The researchers-three nurses and one physician-questioned nearly 100 RNs about their experiences with error disclosure to patients. Most said they talk with patients about errors that are within their control, such as missed medications, but not about errors that involve serious harm or the actions of other members of the healthcare team. In these cases, the responsibility would fall to the patient's physician. However, researchers also noted a low awareness of facility disclosure policies among the RNs.

When nurses aren't involved in the disclosure process, they may become evasive when patients question them about an error. Or they may seem to stall by asking families to write down their questions for the physician. Nurses in the study said they'd like to take part in the disclosure process so they can communicate directly with the patient about nursing's role in the error and avoid taking the blame for it.

Figure. ILLUSTRATIONS BY MICHAEL TRINSEY

Researchers say that poor communication in the disclosure process can lead to moral distress, decreased job satisfaction, and RN turnover. They recommend that hospitals establish policies that allow nurses and other caregivers to participate in error disclosure and that nurse managers be educated about how to tell patients and families about medical mistakes.